Lifetime Rates by GenderLifetime Rates by GenderDisorderDisorder MalesMales FemalesFemales TOTAL (%)TOTAL (%)
Anxiety Anxiety disorderdisorder 1919 31 31 2525
Unipolar Unipolar DepressionDepression 1313 2121 1717
ManiaMania 22 22 22
Substance Substance dependencedependence 3535 1818 2727
Any Any disorderdisorder 4949 4747 4848
Diagnosis: A Necessary StepDiagnosis: A Necessary Step DiagnosisDiagnosis
Process of Process of identifying and identifying and grouping mental grouping mental disorders with disorders with similar symptomssimilar symptoms
DSM-IV DSM-IV American American Psychiatric Psychiatric Association’s Association’s Diagnostic and Diagnostic and Statistical Statistical Manual of Mental Manual of Mental DisordersDisorders (4th (4th Edition)Edition)
Advances in diagnosis and therapy are success stories for clinical psychology/ psychiatry
In 1955, 500,000 institutionalized for psychological disorders
Today: 65,000But mental hygiene arrests continue to this day (suicide, squalor, starving)
Major Affective DisordersMajor Affective Disorders
“The mind is its own place, and of itself
Can make a Heaven of Hell, a Hell of Heaven”
- John Milton (Paradise Lost)
Major Affective DisordersMajor Affective DisordersUnipolarUnipolar BipolarBipolar
Incidence Incidence Up to 20 %Up to 20 % 1.6 %1.6 %
Age diagnosedAge diagnosed 25-45 y25-45 y 20-30 y20-30 y
Sex differenceSex difference Twice rate for Twice rate for femalesfemales
No differenceNo difference
Suicide Suicide attemptsattempts
16 %16 % 30 %30 %
Alcoholism %Alcoholism % (10% of most people per (10% of most people per year)year)
30 %30 % 30 %30 %
MZ MZ concordanceconcordance 100% shared genes100% shared genes
41 %41 % 55 %55 %
DZ DZ concordanceconcordance ~ 50% shared genes~ 50% shared genes
15 %15 % 10 %10 %
Creativity & Mood Creativity & Mood DysfunctionDysfunction
Writers Writers ControlsControls
Mood disorderMood disorder 80 %80 % 30 %30 %
BipolarBipolar 43 %43 % 10 %10 %
AddictionAddiction 30 %30 % 7 %7 %
SuicideSuicide 12 %12 % 0 %0 %
Iowa Writer’s Workshop, Andreasen, 1987Iowa Writer’s Workshop, Andreasen, 1987
Other studies find 30x normal incidence rate in writers, musicians
Why are they linked?
Famous Bipolar ArtistsFamous Bipolar ArtistsHans Christian Anderson Ludwig von Beethoven Lord Byron Charles Dickens T. S. Eliot Ralph Waldo Emerson William Faukner F. Scott Fitzgerald Paul Gauguin Vincent van Gogh
Ernest Hemingway Michelangelo Sylvia Plath Edgar Allan Poe Gordon Sumner (Sting) Peter Tchaikovsky Leo Tolstoy Mark TwainVirginia Woolf Tennessee Williams
Creativity Connection
• Emotional reactive (unfiltered life)
• Disinhibited (loose associations)
• Absorption (focus)
Intense creative episodes during hypomania
Beck Depression Inventory Beck Depression Inventory (BDI)(BDI)
Twenty-one dimensions of depression:1. Sadness 12. Social withdrawal2. Pessimism 13. Indecisiveness3. Sense of failure 14 Change in body image4. Dissatisfaction 15. Retardation5. Guilt 16. Insomnia6. Expectation of punishment 17. Fatigability7. Dislike of self 18. Loss of appetite8. Self Accusation 19. Loss of Weight9. Suicidal ideation 20. Somatic preoccupation10. Episodes of crying 21. Low level of energy11. Agitation
In past week including today:0 = I do not feel sad1= I feel sad2= I am sad all the time and I can’t snap out of it3= I am so sad that I can’t stand it
0-63 max score (30+ indicates severe depression)
Aaron Beck
Treatment for Unipolar Treatment for Unipolar
CognitiveCognitive DrugDrug ECTECT
ImprovemenImprovementt
70%70% 70%70% 80%80%
Relapse rateRelapse rate ModeratModeratee
HigherHigher HigherHigher
Side effectsSide effects NoneNone ModeratModeratee
severesevere
SuicideSuicide30,000 Americans each year
Nearly 2x the homicide rate
8th leading cause of death,
3rd for teens
2 x above the world rate- 16.7/100K Japan (1997)- 11.9/100K USA (1997)
Females attempt 3x males, but males succeed 4x
60% successes with firearms
Since 1950, suicide rates in teens has tripled
Myth of Sisyphus (Camus): “There is only one really serious philosophical question, and that is suicide”
Obsessive-Compulsive Obsessive-Compulsive Disorder (OCD)Disorder (OCD)
• Obsessions: repetitive thoughts
- germs, terrible events, symmetry & order
• Compulsions: repetitive behaviors
- grooming, rituals, checking locks, appliances
Dissociative Identity Dissociative Identity DisorderDisorder
• Previously Previously Multiple Multiple personality personality disorders disorders (MPD)(MPD)
SchizophreniaSchizophrenia
““Split Mind”Split Mind”
Disorders Disorders involving gross involving gross distortions of distortions of thoughts and thoughts and perceptions and by perceptions and by loss of contact loss of contact with realitywith reality
Scz – the Disorder of Science and MathScz – the Disorder of Science and Math
Isaac Newton – suffered psychotic Isaac Newton – suffered psychotic break break
Albert Einstein – autistic traits, Scz sonAlbert Einstein – autistic traits, Scz son
John Nash Jr – chronic schizophreniaJohn Nash Jr – chronic schizophrenia
Bertrand RussellBertrand Russell
James Joyce’s daughterJames Joyce’s daughter
Syd Barrett (of Pink Floyd)Syd Barrett (of Pink Floyd)
Socrates (perhaps, or Socrates (perhaps, or
temporal lobe epilepsy)temporal lobe epilepsy)
Types of SchizophreniaTypes of Schizophrenia
• ParanoidParanoid: Delusions or : Delusions or hallucinations often include hallucinations often include extreme suspiciousness and extreme suspiciousness and hostility hostility
• DisorganizedDisorganized: Exhibit signs : Exhibit signs of illogical thinking and of illogical thinking and speechspeech
• CatatonicCatatonic: Exhibit : Exhibit extremes in motor behaviorextremes in motor behavior
• UndifferentiatedUndifferentiated: Do not : Do not clearly fit into a typeclearly fit into a type CatatoniaCatatonia
Positive & Negative Positive & Negative SymptomsSymptoms
• Positive Sx: cognitive, emotional, Positive Sx: cognitive, emotional, and behavioral and behavioral excessesexcesses..– hallucinations, delusions, thought disorders, and hallucinations, delusions, thought disorders, and
bizarre behaviors.bizarre behaviors.
• Negative Sx: cognitive, emotional, Negative Sx: cognitive, emotional, and behavioral and behavioral deficitsdeficits..– apathy, flattened affect, social withdrawal, apathy, flattened affect, social withdrawal,
inattention, and slowed speech or no speech.inattention, and slowed speech or no speech.
Schizophrenia ratesSchizophrenia rates
• 1% across all cultures, despite few offspring1% across all cultures, despite few offspring• Male = females, or slightly more malesMale = females, or slightly more males• More in jails than psychiatric hospitalsMore in jails than psychiatric hospitals• 50% never accept that they are ill50% never accept that they are ill• 90% go off meds once+ (relapse within 3y)90% go off meds once+ (relapse within 3y)• Nearly 100% smoke (self-stimulation)Nearly 100% smoke (self-stimulation)• Higher prevalence in lower socioeconomic classHigher prevalence in lower socioeconomic class• 25% full remission, 50% recurrent relapses 25% full remission, 50% recurrent relapses
(living independently on meds or less (living independently on meds or less autonomously in group homes), 25% autonomously in group homes), 25% permanently hospitalizedpermanently hospitalized
• 40% attempt suicide, 10% succeed40% attempt suicide, 10% succeed
DSM-IV CriteriaDSM-IV Criteria
•DelusionsDelusions
•HallucinationsHallucinations
•Speech changesSpeech changes
•Motor symptomsMotor symptoms
•Mood symptomsMood symptoms
•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months
Delusions – incorrect Delusions – incorrect conclusions conclusions about about
perceptionsperceptions•Peculiar beliefs, culturally based Peculiar beliefs, culturally based
aliens, secret lovers, paranoia, grandiosity, thought aliens, secret lovers, paranoia, grandiosity, thought insertion or broadcast, erotomaniainsertion or broadcast, erotomania
• Ideas of reference Ideas of reference events has special personal meaningevents has special personal meaning
•Magical thinking Magical thinking control events from afarcontrol events from afar
DSM-IV CriteriaDSM-IV Criteria
•DelusionsDelusions
•HallucinationsHallucinations
•Speech changesSpeech changes
•Motor symptomsMotor symptoms
•Mood symptomsMood symptoms
•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months
Hallucinations Hallucinations – inaccurate – inaccurate perceptionsperceptions
Most auditory; some visual, olfactory, Most auditory; some visual, olfactory, tactiletactile
•Commanding voice of authority – Commanding voice of authority – God, historical figure, parent alive God, historical figure, parent alive or deador dead
•Derisive, insultingDerisive, insulting
•Running commentary of life, Running commentary of life, feelings, thoughtsfeelings, thoughts
DSM-IV CriteriaDSM-IV Criteria
•DelusionsDelusions
•HallucinationsHallucinations
•Speech changesSpeech changes
•Motor symptomsMotor symptoms
•Mood symptomsMood symptoms
•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months
Speech changesSpeech changes
•Mute vs pressured (“word salad”)Mute vs pressured (“word salad”)
• Insensitive to the informational Insensitive to the informational needs of audienceneeds of audience
•Overall, a poverty of speechOverall, a poverty of speech
DSM-IV CriteriaDSM-IV Criteria
•DelusionsDelusions
•HallucinationsHallucinations
•Speech changesSpeech changes
•Motor symptomsMotor symptoms
•Mood symptomsMood symptoms
•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months
Motor symptomsMotor symptoms
•CatatoniaCatatonia
•Peculiar (e.g., strip naked to greet)Peculiar (e.g., strip naked to greet)
•Bizarre gestures, grimacesBizarre gestures, grimaces
•Stereotypies (rocking, flapping)Stereotypies (rocking, flapping)
•Violence to self, or family Violence to self, or family membersmembers
DSM-IV CriteriaDSM-IV Criteria
•DelusionsDelusions
•HallucinationsHallucinations
•Speech changesSpeech changes
•Motor symptomsMotor symptoms
•Mood symptomsMood symptoms
•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months
Mood symptomsMood symptoms
•Blunted, inappropriate, or Blunted, inappropriate, or exaggeratedexaggerated
•Flat affect, anhedonia, avolitional, Flat affect, anhedonia, avolitional, vegetativevegetative
•SuicidalSuicidal
DSM-IV CriteriaDSM-IV Criteria
•DelusionsDelusions
•HallucinationsHallucinations
•Speech changesSpeech changes
•Motor symptomsMotor symptoms
•Mood symptomsMood symptoms
•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months
Cognitive SymptomsCognitive Symptoms
•Attention disorderAttention disorder
•Loose associationsLoose associations (“knight’s (“knight’s move”)move”)
•Memory impairmentMemory impairment
•Executive functioning – serial, Executive functioning – serial, perseveration, monitoringperseveration, monitoring
Impaired Theory of MindImpaired Theory of Mind
•Failure to monitor Failure to monitor – what different people can knowwhat different people can know– one’s own intentional actionsone’s own intentional actions– informational needs of othersinformational needs of others– one simply thought somethingone simply thought something– mental and physical distinctionsmental and physical distinctions
Course of Onset (Warning Course of Onset (Warning signs)signs)• <7y: Failure to develop dominant hand early (55% autistics fail <7y: Failure to develop dominant hand early (55% autistics fail
as well)as well)
• 8-12 y: interpersonal problems, poor emotional control, high IQ, 8-12 y: interpersonal problems, poor emotional control, high IQ, sensitivesensitive
• 12-16y: cognitive problems begin, underachievement, 12-16y: cognitive problems begin, underachievement, disorganized thoughts, poor emotional rapport, few friendsdisorganized thoughts, poor emotional rapport, few friends
• 17-20y: [prodomal or precursory] 17-20y: [prodomal or precursory] withdrawalwithdrawal, decreased , decreased grooming, altered school or work performance, delusions grooming, altered school or work performance, delusions emerging, abuse hallucinogens like marijuana or LSDemerging, abuse hallucinogens like marijuana or LSD
Risk of developing Risk of developing schizophrenia in schizophrenia in one’s lifetime one’s lifetime increases as increases as genetic relatedness genetic relatedness with a diagnosed with a diagnosed schizophrenic schizophrenic increases.increases.
Dopamine hypothesisDopamine hypothesis
Genetic ComponentGenetic Component
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